Re: PMB on coumadin
From: Meenan, Anna (annam@uic.edu)
Mon Apr 30 14:35:00 2007
Prohylaxis not recommended for routine gyn procedures such as
endometrial bx or IUD insertion when no active infection present,
even in high-risk pts. Per AHA 1998.
Anna Meenan, MD
>I agree Art, I think the no prophylaxis for gyn procedures only applies
>to people at low risk of endocarditis (ie mitral valve prolapse). I
>think artificial valves falls into the high risk for infection category.
>
>Glen
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
>fougner, md
>Sent: Monday, April 30, 2007 2:10 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: PMB on coumadin
>
>With an artificial heart valve?
>
>Art
>
>At Mon, 30 Apr 2007, Atkinson, Samuel M wrote:
>>
>>I believe you will find that the antibiotic recommendations do not
>apply
>>to gyn proc like d&c, cerv bx etc. Of course the last time I pointed
>it
>>out to anesthesia they insisted intubation was a risk so my pt got Rxed
>>for a CKC/D&C. I do not believe Endo bx re quires prophy Rx.
>>
>>________________________________
>>
>>________________________________
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry
>>
>>--
>>________________________________
>>Gregor
>>________________________________
>>Sent: Sunday, April 29, 2007 7:12 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: PMB on coumadin
>>
>>Sam,
>>
>>Thanks to you and to all othr respondent listers. Endo bx was my
>minimum
>>assessment choice, and I guess, without verbalizing it to myself or
>>others, I was wondering whether a hysto/D&C would be warranted.
>However,
>>I've always felt the literature supports endobx as a very correlative
>>procedure vis a vis hyto/D&C results, so felt - feel - I should go
>ahead
>>with the sampling I'd usually do. Can't find anything definitive re the
>>abx prophylaxis, so I will go ahead with that.
>>
>>In the last ten years, I've had three ca cases whose presentations were
>>just the scantes amts of pmb...two were localized and WD'd...one was
>>poorly diff'd and fairly diffuse within the cavity, but with less than
>>1/3rd penetration. Years ago, when I was a student, there was a fellow
>>named Fred Hoffmeister (department head, Univ of Wisconsin, I believe)
>>whom I heard speak...he was adamant about bx'g all PM women before
>>initiating HRT. Used to say if bx's weren't done then ca's and atypical
>>aden's hyperplasias would get erroneously attributed to HRT. Most ot
>the
>>attendings I came in contact as a student and a resident would indicate
>>his view was excessive...however, I bet he didn't miss too many, if
>any,
>>abnl endometriums.
>>
>>Hank
>>
>>"Atkinson, Samuel M" <ATKINSONS@ecu.edu> wrote:
>>
>> Hank: I have had two patients sinilar to yours, altho a bit
>>older that i found endo ca by biopsy. I have taught residents that a
>bad
>>lesion bleeds earlier on rat poisin and that they all must be biopsied.
>>I admit that not all have endo ca hower.. for whiw.
>> sAm
>>
>> ________________________________
>>=09
>> ________________________________
>> ________________________________
>> From: ob-gyn-l@obgyn.net on behalf of Henry Gregor
>> Sent: Fri 4/27/2007 11:47 AM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: PMB on coumadin
>>
>> Listers
>>
>> A 53 yo, LMP 4 years ago, presents with two weeks plus heavy
>>vaginal bleeding, w/o presyncopal sx's. She is on coumadin secondary to
>>hx of mitral valve replacement. INR is 2.3, and pt is w/o petechiae,
>>ecchymoses, or hx of epistaxis or bleeding gums, etc.
>>
>> PE is unremarkable, and a pap (neg hx abnl past ones) is
>>pending. Sono with heterogenous endometrial stripe, at 7 mm. I am
>>planning to do an endometrial pipelle sampling. Comments appreciated.
>>
>> Thanks
>>
>> Hank
>>
>> ________________________________
>>=09
>> ________________________________
>> ________________________________
>> Ahhh...imagining that irresistible "new car" smell?
>> Check out new cars at Yahoo! Autos.
>>
>>________________________________
>>
>>________________________________
>>Ahhh...imagining that irresistible "new car" smell?
>>_
>>-
>>>
>
>--
>art fougner, md
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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